Tag Archives: harm minimisation

OPPONENTS of patients being able to medicate with natural herbal cannabis,including our own Ministry of Health, can no longer ignore its medical effectiveness. Instead, they deny relief to seriously ill people by hiding behind smokescreens and circular arguments. CHRIS FOWLIE explains.

The Ministry of Health supports allowing the cannabis-extract Sativex. This in itself is not a bad thing. Sativex is, after all, a natural extract made from whole cannabis. Its genetics are based on quality Sensi Seed Bank stock. But it’s not yet available in New Zealand – and it’s not for everyone. Sativex has a fixed ratio of just two cannabinoids, whereas the variety of cannabis strains allow patients to pick and choose to match strains to symptoms. And Sativex is expensive – an estimated cost of $150-$300 per week, with no sign Pharmac will offer any funding.

Smoking

Objectors to herbal cannabis say smoking anything must be bad. That assumes all smoke is smoke, but cannabis smoke is different: for a start, it contains THC, a powerful antioxidant with tumour-fighting abilities. THC kick-starts the lung’s immune response, and clears the lungs. Several large-scale studies have thus found cannabis-only smokers to be more healthy than even non-smokers!

Next they talk about cannabis smokers taking deep breaths and holding it in longer. But it is the vastly-inflated value caused by its illegal status that forces tokers to maximise the bang for their buck. If cannabis cost the same as tobacco ($20 per ounce including taxes), we’d see a more relaxed smoking style.

Even if we accept anti-smoking arguments, herbal cannabis does not have to be smoked. Patients can avoid smoke entirely by growing cannabis and turning it into foods, drinks or tinctures, or even skin creams or massage oils. They can use a vaporiser to get the instant effect and dose control of inhalation without any smoke at all.

Standard dosages

The next objection that is usually raised is that there can be no standardisation or dosage control with herbal cannabis. But smoking actually provides patients with very precise dosage control, due to the instant onset of effects. Furthermore, baked foods, drinks, candies, chocolates, elixirs and tinctures can all be easily made to a standard recipe that delivers a product of known strength. Anyone who can follow a recipe can do it. For larger-scale production, places overseas have
met patient need by licensing community groups, pharmacies or local companies to produce natural extracts or tinctures of known strength. The Dutch licensed several companies to provide standardised natural cannabis to pharmacies there. The varieties all have fixed and known quantities of active ingredients and are sterilised to be free of mould or fungus. It is that not hard to do, and could easily be done here.

Home invasions

Finally, those who object to herbal medicinal cannabis eventually say that allowing patients to grow their own would expose them to risk of robbery or home invasion, acknowledging that the current drug law creates crime and violence. Regardless, many patients are already growing their own, but are denied any protection. If their medicine is stolen they can’t go to the police. Patients are forced to engage with the illicit market and the risks that go with that. Places overseas that allow patients to grow their own or nominate someone else to do it for them have not noted increased violence of thefts from patients. To the contrary, allowing patients to grow their own is the best way to safely meet their needs.

I drafted these guidelines for Sensible Cannabis Use, with input and peer review from leading researchers and consumer advocates. As Editor of NORML News I ensured they ran in every issue. NORML is a consumer advocacy organisation dedicated to reducing harm and encouraging more sensible drug laws. I had it adopt a set of Principles of Responsible Cannabis Use that define and limit acceptable use.

Safer Cannabis Use

Although the vast majority of people who use cannabis suffer no harm, some do experience problems. Ensure that your cannabis use does not impair your health, family, employment and education, and try to have periods of reducing use or not consuming cannabis.

Harm reduction:

Remember that “Less is More” – the less you use, the less you will need, and the more high you will get.

NORML recommends consuming organic cannabis.

Heavy long term cannabis use may lead to some respiratory damage. Deep tokes and long breath duration are more harmful to the lungs.

Water pipes and bongs help cool the smoke, filter solids, and absorb some of the most harmful tars in the water. Bongs can make the smoke very smooth, so avoid inhaling too deeply. Replace bong water each time and regularly sterilise your pipe or bong (eg using meths, alcohol or denture cleaning tablets)

Meningitis and other diseases can be transmitted through saliva, so don’t share spit on joints or pipes. Try using your hands like a chillum to hold the joint, especially if someone in the circle has the flu!

Try other ways of ingesting cannabis, such as eating or drinking it, or using a vaporiser to heat the herb and release THC without combustion.

When eating cannabis preparations, start with a small piece and wait an hour before increasing the amount, if desired. The effects of edible cannabis products may be stronger than smoked cannabis.

Health warnings:

Cannabis is best avoided by pregnant and breastfeeding women.

People with a history of severe mental illness should reduce any cannabis use to a level agreed with their clinician, or avoid cannabis altogether.

Those receiving digitalis or other heart medications should consult their doctors before using cannabis.

Mixing cannabis with alcohol can make you more out of it than you intended. The anti-nausea effect of cannabis may also cause you to drink more.

Mixing cannabis with tobacco means more smoke damage to your lungs, and may make you become nicotine dependent.

NORML’s Principles of Responsible Marijuana Use

Adults Only. Cannabis consumption is for adults only. It is irresponsible to provide cannabis to people aged under 18.

Safe Driving. The responsible cannabis consumer does not operate a motor vehicle or other heavy machinery while impaired by cannabis, nor (like other responsible citizens) impaired by any other substance or condition, including some prescription medicines or fatigue.

Set and Setting. The responsible cannabis user will carefully consider his/her mind-set and physical setting, and regulate use accordingly.

Resist Abuse. Use of cannabis, to the extent that it impairs health, personal development or achievement, is abuse, to be resisted by responsible cannabis users.

Respect the Rights of Others. The responsible cannabis user does not violate the rights of others, observes accepted standards of courtesy, and respects the preferences of those who wish to avoid cannabis.

The Government has announced a review of the National Drug Policy and this means it is your chance to have your say.

The current policy is harm minimisation, which means policies and government agencies should
seek to reduce overall harm even if it means people continue to use drugs. One example is the
needle exchange and methadone network. Another example is NORML’s tips for safer cannabisuse.

The NDP review is to:

assess the effectiveness of the current policy

review the impact of the NDP in terms of stakeholder support and its contribution to reduction of drug related harm

identify options for future drug policy directions

determine the best approach for a future National Drug Policy including the relative focus on strategic versus action oriented approaches

develop a draft Strategy for endorsement by Government, including a process for evaluating the effectiveness of that

New Zealand led the world in introducing this policy, and although evidence shows harm minimisation is the most effective policy, it is not without it’s critics including many politicians who campaign on “tough on crime” platforms. This includes United Future’s Peter Dunne, who has tried to get the wording of the policy changed so that it is more orientated around abstinence.

The document outlines areas of supply control, demand reduction and problem limitation. Proposals range from toughening law enforcement, better drug education, more work on pricing
and tax policy for alcohol and tobacco, and improving access to treatment. It also said more
needed to be done on collecting data.

Associate Health Minister Jim Anderton said the policy tried to take a more economic view of the harms caused by drugs, rather than just the health effects. He emphasised legal drugs such as alcohol and tobacco caused far more harm than illegal drugs — between 70-90 per cent of criminal activity related to alcohol use and 4700 deaths a year were from tobacco use.

Five regional meetings will be held in Auckland, Palmerston North, Wellington, Christchurch and Dunedin. Separate hui, with a focus on issues for Maori, will be held in Auckland, Wellington,
Christchurch, Whangarei, Gisborne and Rotorua. Written or emailed submissions can also be made. The cannabis inquiry held from 1999-2003 was greatly promising until the evidence was overridden by the politics and grandstanding. Don’t let it happen again. Have your say and help make New Zealand’s drug policy evidence-based.

We encourage you to get involved in the political process for these bills. Write a submission and have your say. Make your views known. The draft document is available at www.ndp.govt.nz and you have until 26 May to make a submission.

A coroner’s call to escalate the “War on Drugs” received a lot of media coverage, but was condemned by health professionals including the Drug Foundation and the Public Health Association.

In calling for a return to “just say no” education, Wellington coroner Garry Evans had ignored best practice and a wealth of international evidence in his attack on the current policy of harm minimisation, said the Drug Foundation.

“It sounds really sensible to take a tough approach … but what that ignores is the reality of human nature,” said New Zealand Drug Foundation executive director Ross Bell. “Human beings have been finding ways of altering their state of mind for thousands of years. In spite all of that law enforcement people are still using drugs.”

“The drug-war approach has seen drug use rise significantly for 20 years in the US, while it locks away more citizens than any other developed nation. New Zealand per capita sits second in that statistic; we need policies that ensure we at least rise no higher.”

Mr Bell also questioned whether the coroner’s recommendations can be supported by his findings into the deaths of six young people.

“Mr Evans has drawn a very long bow by recommending a major overhaul of New Zealand’s drug policy and education based on the findings of six tragic deaths from gas inhaling. Indeed, his recommendation for a national drug education campaign ignores all the evidence about how to most effectively deal with inhalant abuse, which actually warns against publicising the issue because it can lead to increased inhalant abuse.”

Bugger the evidence though, coroner Evans says the current official policy of harm minimisation, which accepts that people will take drugs and tries to make it safer, just sends the wrong message. Evans cited unpublished research from Prof Richard Beasley of Wellington’s Medical Research Institute, who has been trying to see if smoking cannabis causes lung cancer. The study is incomplete and has not been peer reviewed, but Beasley speculated that because Maori have higher rates of lung cancer than non-Maori, and because Maori smoke cannabis at a higher rate, that cannabis could be the cause. This was widely reported in the media as evidence that cannabis may cause cancer. But official statistics show Maori smoke cannabis at only a slightly higher rate: 20% are current users, compared to 18% of the total sample.

In his paper, Beasley cited old research by Donald Tashkin of the USA, whose research into lung damage is often cited by drug prohibitionists. Beasley was, however, unaware of more recent research by Tashkin, which was reported in the Winter 2005 issue of Norml News. Marijuana smokers were found to have a lower rate of lung cancer than even nonsmokers. Tashkin found that marijuana is less carcinogenic than tobacco smoke and may even have some anticancer properties.

Robert Melamede, chair of biology at the University of Colorado in Boulder, recently published a review of studies in the Oct. 17 issue of Harm Reduction Journal. He found that although cannabis smoke and tobacco smoke are chemically very similar, the cancer-promoting effects of smoke are increased by nicotine, while they are reduced by THC.

Anti-drug zealots Pauline Gardiner and Trevor Grice rallied round in support of Evans. Gardiner – who once said that “we’d be better off if all dope-smokers died, because then the state wouldn’t have to support them” – was proposed by Grice to be NZ’s first “drug czar”, in charge of all drug policy and enforcement. Mr Evan’s recommendations had included using specialists – such as Gardiner and Grice – to deliver drug education in schools.

However, the PHA’s Dr Keating says that evidence suggests that school drug education programmes should be taught by teachers, and there is a “question mark over the effectiveness of programmes delivered by outside agencies”.

“At the moment we have the bizarre situation of organisations like the Life Education Trust going into schools and offering programmes that include smoking prevention, even through the Trust receives funding from British American Tobacco. We should be asking why it is that tobacco manufacturers are so keen to support youth smoking prevention programmes. Could it be because they know they certain types of programmes don’t work?.”

Drug policy has little if any impact on whether people choose to use drugs or not, but it does effect how much harm an individual and their community is exposed to.

The Government claims the current policy is one of “harm minimisation”, yet criminalisation does not stop people using cannabis, it fails to prevent harms that may be associated with it’s use, and it creates more problems than it prevents. The Government spends over $50 million per year criminalising more than ten thousand mostly young people for a herb that is normal to use and proven to be less harmful than alcohol or tobacco. Prohibiting such a popular and benign past-time forces cannabis buyers to score from criminals, which fuels organised crime and official corruption, creates disrespect for the law, and in turn undermines drug education and prevention efforts.

The American alcohol prohibition of the 1900s was repealed after a campaign by Mothers Against Prohibition, who said “Save Our Children: End Prohibition”. This “noble experiment” that had attempted to ban alcohol – which is, like cannabis, a socially acceptable and widely used drug – had only created powerful mobsters who engaged in open warfare with police and used children in their distribution chain as well as their customer base. Prohibition failed to reduce alcohol use, but did increase the harm to users who were forced to fraternise with criminals and drink poisonous “moonshine” alcohol.

We can see the same situation in New Zealand today. Cannabis prohibition has created mobsters who will sell cannabis of unknown safety and purity to anyone, regardless of age. Rather than controlling cannabis, prohibition removes all control and places it in the hands of those prepared to break the law. Cannabis prohibition has also failed to reduce use, with half the country prepared to admit they have tried cannabis. Few people today would agree that anyone should be arrested for smoking a joint.

Having now passed the coffeeshop training course and investigated cannabis policies in North America and Europe, it is apparent that in contrast to the lack of control prohibition has given us, society can have the most control over the way cannabis is used by regulating and licensing outlets in a similar way to how we regulate the sale of alcohol and tobacco.

I believe it is only a matter of time before coffeeshops are open in New Zealand. However, every jurisdiction that now has a progressive drug policy, has that as a result of dedicated and principled people putting ideas into action, rather than the pipe dream of governments one day coming to their senses and ending the war on drug users.

I have said I intend to open a coffeeshop when I return to New Zealand later this year, but I am not seeking a confrontation. I would like to work with the authorities and will apply to the government for a license. The Misuse of Drugs Act allows licenses for the consumption of a controlled drug to be issued for the purposes of “research or study”. I agree that researching the effects of our drug policy is absolutely essential. It is a shameful indictment that we have tolerated cannabis prohibition for sixty years and it has never been researched properly, even though it is obvious to all that prohibition has failed. We should at least trial a coffeeshop – using the proven Dutch rules – and study whether such a system of controlled availability is an improvement over attempting to drive cannabis underground.

Having coffeeshops will allow consumers of cannabis to be educated about responsible cannabis use in a non-threatening environment. Coffeeshops will separate hundreds of thousands of cannabis buyers from unscrupulous hard drug sellers, will and make it difficult for teenagers to access cannabis, unlike the current situation. Allowing coffeeshops will improve community respect for the police and the law, and will allow both the harmful and therapeutic effects of cannabis to be discussed openly. Opening coffeeshops could save the taxpayer around NZ$50 million per year in law enforcement costs, and generate significant taxation revenues that could be dedicated to drug education, prevention and rehabilitation efforts. Licensing cannabis cafes will send the message that society can deal with widely used and socially acceptable drugs in a way that is consistent, rational and evidence-based.

I am confident that like in the Netherlands, Canada and the United Kingdom, once the first coffeeshop is open it will become obvious that cannabis prohibition has been a dreadful mistake. Or is that what some people are afraid of?